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CASE REPORT
Adv Biomed Res 2016,  5:77

Primary ectopic frontotemporal extradural craniopharyngioma


1 Department of Neurosurgery, Alzahra Hospital, Isfahan, Iran
2 Department of Neurosurgery, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Submission20-Jul-2015
Date of Acceptance20-Oct-2015
Date of Web Publication21-Apr-2016

Correspondence Address:
Dr. Bahram Seif
Department of Neurosurgery, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-9175.180989

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  Abstract 

We present a case of primary ectopic frontotemporal extradural craniopharyngioma. Primary ectopic craniopharyngiomas are very rare and have been reported involving the fourth ventricle, infrasellar region, lateral ventricle, temporal area, cerebellopontine angle, clivus, corpus callosum, and prepontine cistern. There was just 1 case of craniopharyngioma previously presented in the literature, with nearly same location as the presenting case.

Keywords: Ectopic craniopharyngioma, extradural tumor, extradural cystic lesion


How to cite this article:
Pourkhalili R, Shekarchizadeh A, Seif B. Primary ectopic frontotemporal extradural craniopharyngioma. Adv Biomed Res 2016;5:77

How to cite this URL:
Pourkhalili R, Shekarchizadeh A, Seif B. Primary ectopic frontotemporal extradural craniopharyngioma. Adv Biomed Res [serial online] 2016 [cited 2019 Sep 20];5:77. Available from: http://www.advbiores.net/text.asp?2016/5/1/77/180989


  Introduction Top


Craniopharyngiomas are relatively benign neoplasms (WHO Grade I) and account for 2.5–4% of all intracranial tumors.[1] They typically arise in the sellar and suprasellar regions.[2] Primary ectopic craniopharyngiomas are very rare and have been reported involving the fourth ventricle, infrasellar region, lateral ventricle, temporal area, cerebellopontine angle, clivus, corpus callosum, and prepontine cistern.[3],[4],[5],[6],[7],[8],[9],[10] We present a case of primary ectopic frontotemporal extradural craniopharyngioma that treated surgically.


  Case Report Top


The patient is a 17-year-old girl, with chief complaint of severe headache for 4 months. The headache was mostly sensed in the frontal region and vertex, and sometimes followed by the episodes of nausea and vomiting. Past medical history and drug history were not significant. Neurologic examination revealed no localized findings and neurological deficits.

The patient underwent brain magnetic resonance imaging (MRI). There was an extra axial heterogeneous mixed solid and cystic mass at the left frontal and temporal areas. Its measurement was 18 mm × 36 mm × 66 mm. High signal intensity in T1, and hyposignal to isosignal T2 was noted inside the lesion. There was no remarkable enhancement after the contrast administration [Figure 1].
Figure 1: Magnetic resonance imaging studies showing an extra axial heterogeneous mixed solid and cystic mass at the left frontal and temporal areas. (a) Axial T1-weighted magnetic resonance imaging and (b) sagittal T1-weighted magnetic resonance imaging exhibiting a high signal intensity extra axial mass. (c) Axial T2-weighted magnetic resonance imaging and (d) coronal T2-weighted magnetic resonance imaging showing a hyposignal to isosignal mass. (e) Axial T1-weighted magnetic resonance imaging with gadolinium showing no remarkable enhancement after contrast administration. (f) In sagittal T1-weighted magnetic resonance imaging with gadolinium sellar and suprasellar region appear normal

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She underwent surgery and total tumor resection was done via the left frontotemporal craniotomy. There were 2 extradural cystic lesions contain dark gray opaque fluid [Figure 2]. There was also a solid component into each cyst. Postoperative MRI revealed no signs of tumor residual.
Figure 2: After removal of the bony flap, we saw extradural cystic lesions contain dark gray opaque fluid

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The pathological light microscopy analysis of lesions revealed, cystic areas covered by squamous and basaloid epithelium that contain homogenous eosinophilic contents. In some parts of cyst walls, there were infiltration of inflammatory cells, cholesterol cleft formation, and calcification [Figure 3]. These findings were correlating with an ectopic craniopharyngioma.
Figure 3: Pathological light microscopy analysis of the lesions shows cystic areas covered by squamous and basaloid epithelium that contain homogenous eosinophilic contents. In some parts of cyst walls, there were infiltration of inflammatory cells, cholesterol cleft formation and calcification (H and E, ×200)

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  Discussion Top


Ectopic presentation of craniopharyngioma is rare. In most cases, ectopic seeding occurs secondary and after the removal of primary suprasellar tumors by direct mechanical implantation of the tumor cells, or via meningeal seeding.[6] There was just 1 case of primary craniopharyngioma previously presented in the literature nearly at the same location, as the case we presented above. Ectopic migration of cell remnants of the obliterated craniopharyngeal canal might be the cause.


  Conclusion Top


We presented a case of primary ectopic frontotemporal extradural craniopharyngioma. As the treatment of choice for these mass lesions, aggressive surgical resection of the lesion was done. We plan to follow this case with serial brain MRI. Craniopharyngioma should be mentioned as a differental diagnosis for intracranial extradural mass lesions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Tayari N, Etemadifar M, Hekmatnia A, Mahzouni P, Maghzi AH, Rouzbahani R. Intrinsic third ventricular craniopharyngioma: A case report. Int J Prev Med 2011;2:178-85.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Falavigna A, Kraemer JL. Infrasellar craniopharyngioma: Case report. Arq Neuropsiquiatr 2001;59:424-30.  Back to cited text no. 2
    
3.
Shah GB, Bhaduri AS, Misra BK. Ectopic craniopharyngioma of the fourth ventricle: Case report. Surg Neurol 2007;68:96-8.  Back to cited text no. 3
    
4.
Nourbakhsh A, Brown B, Vannemreddy P, Lian T, Nanda A, Guthikonda B. Extracranial infrasellar ectopic craniopharyngioma: A case report and review of the literature. Skull Base 2010;20:475-80.  Back to cited text no. 4
[PUBMED]    
5.
Singh J, Ganesan K, Desai SB, Kohli A, Kaushik E. Lateral ventricle craniopharyngioma – MRI demonstration of migratory nature of ectopic craniopharyngioma from the suprasellar region. Neuroradiology 2003;13:427-9.  Back to cited text no. 5
    
6.
Banczerowski P, Bálint K, Sipos L. Temporal extradural ectopic craniopharyngioma. Case report. J Neurosurg 2007;107:178-80.  Back to cited text no. 6
    
7.
Sharma M, Mally R, Velho V, Hrushikesh K. Primary isolated cerebellopontine angle papillary craniopharyngioma. Neurol India 2012;60:438-9.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Kawamata T, Kubo O, Kamikawa S, Hori T. Ectopic clival craniopharyngioma. Acta Neurochir (Wien) 2002;144:1221-4.  Back to cited text no. 8
    
9.
Sangiovanni G, Tancioni F, Tartara F, Gaetani P, Rindi G, Passeri F, et al. Ectopic craniopharyngioma: Presentation of a case arising from the corpus callosum. Acta Neurochir (Wien) 1997;139:379-80.  Back to cited text no. 9
    
10.
Lee IH, Song CJ, Yeon JS, Kim SH, Song KS, Yeo MK. Craniopharyngioma in the prepontine cistern. AJNR Am J Neuroradiol 2011;32:E57.  Back to cited text no. 10
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


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